Retzius-Sparing Modified Anatomical Structure Preserving and Retzius-Repairing Robotic-Assisted Radical Prostatectomy: A Prospective Randomized Comparison on Functional Outcomes with a 1-Year Follow-Up.

To compare the short-term and 1-year follow-up functional outcomes of modified anatomical structure preserving and Retziusrepairing robot-assisted radical prostatectomy (APR-RARP) compared with Retzius-sparing (RS) RARP. Eighty consecutive patients 40-75 years of age with low-intermediate risk prostate cancer were prospectively randomized to APR-RARP or RS-RARP. Urinary continence (UC) recovery rates were evaluated from catheter removal up to 1 year follow-up. Postoperative UC was defined as 0 pads/one security pad per day. UC recovery rates from catheter removal to 1 year were calculated by Kaplan-Meier curve; log-rank test was used for the curve comparison. Postoperative potency was evaluated at 3 and 12 months after surgeries. Perioperative complications, positive surgical margin (PSM), and biochemical recurrence rates represent secondary outcomes reported in the study. At the catheter removal, 1, 3, 6, and 12 months after operation, 52.5% (confidence interval [CI] 95%: 37.6-67), 82.5% (CI 95%: 70.8-94), 95% (CI 95%: 88.3-99.1), 97.5% (CI 95%: 92.5-99.9), and 97.5% (CI 95%: 92.5-99.9) of men undergoing the APR-RARP were continent (0 pads/one security pad per day), compared with 61.5% (CI 95%: 46.5-76.6), 89.7% (CI 95%: 80.3-98.1), 97.5% (CI 95%: 92.6-99.9), 97.5% (CI 95%: 92.6-99.9), and 97.5% (CI 95%: 92.6-99.9) undergoing the RS-RARP, respectively, and the Kaplan Meier curve showed no statistically significant difference for both technique at any time point (log-rank  = 0.556). The median (95% CI) time to UC recovery was 9.8 (5.2-14.4) days for the APR-RARP 6.7 (3.2-10.2) days for the RS-RARP group. Potency rates were similar in both groups at 3 and 12 months after surgeries. The two compared approaches; in terms of rate of complications, PSM was similar. Surgeons can achieve functional results comparable to the RS technique with the modified reconstructive anterior approach, without changing the surgical technique they are used to.